The hospital starts to feel familiar, less like a place I pass through quickly without looking around, hoping I’ll forget I was there, like an airport or a public restroom. It has morphed into a location in which I know where to find the comfortable chairs. I’ve been here so often over the past three months, I recognize the ever-changing rotation of assistants and technicians, striding purposefully through keycard-locked sliding doors in their dark blue scrubs. I now use the commercial-grade Keurig coffee maker in the waiting area, rather than staring at it as a distant thing, placidly thinking, “It’s so nice that they offer that for people who need it,” while not using it myself because I didn’t need it, because I wasn’t going to be here very long, because everything is going to be fine.

I meet specialists in exam rooms and report on how things have gone. Eventually, the doctor comes in and takes the seat next to me, sliding into the armless chair on a folded leg, turning to face me as though we are old friends and not two people discussing a difficult medical situation, an illness that doesn’t seem to be getting better.

I’m not here for my own health, nor am I here to serve as advocate for an ailing parent or spouse.

I’m here for a cat.

Five weeks ago, I had a feeding tube installed in my cat Rufus, whose liver was failing owing to a sudden weight loss, which brought about something called hepatic lipidosis, a disease in which a cat’s liver, poorly suited to metabolizing adipose tissue, becomes choked with fat. I had thought that the tube would mark the beginning of his recovery, but instead he has wobbled to and fro in his illness, never really bouncing back the way the success stories predicted he would.

Spending a lot of time and money on your cat’s medical care really shows you who your friends are. True friends don’t question your decisions to your face, because they know you are probably doubting your sanity already. True friends don’t ask you if maybe you’d be better off euthanizing the cat, or if all of this effort and expense is really "worth it" — they trust your ability to make rational decisions, even if this ability has not been definitively proven in the past, and offer only support and optimism. This, at least, is what my true friends should do, because that is what I need from them.

It’s not just a financial investment. Amongst those who know me well, I am far from renowned for my caretaking nature. It simply isn’t something I do well, or that I particularly enjoy, these being chief reasons why my husband and I have yet to produce or procure human offspring, and have seriously considered not doing so at all.

Rufus, however, is currently in need of my care, all day long. His need is so intense that I cannot even be out of the house for more than three hours before I must get home to tend to him. This puts demands on all my weakest points, and my reluctance is irrelevant — these are things that must be done, and I must be the one to do them.

My husband says characterizing myself in this way is uncharitable, that I can be caring in times of crisis, but what looks like care to him is more properly recognized as my overwhelming need to fix things that are broken, quickly, quietly, seamlessly, so no one can tell anything was ever wrong. My father has jokingly suggested that the present situation with Rufus is preparation for my future caretaking of him, in his declining years — an early training in caring skills I will one day need for bigger problems. My mother, too, texted me this weekend saying, "I think having pets is preparation for life — it can be heartbreaking." (Which is heartbreaking, I wanted to ask, life, or having pets?)

Both of my parents are extraordinarily healthy — touch wood — and to my knowledge neither of them has ever been hospitalized. Even I can’t claim that, having been de-gallbladdered in my 20s. But I am of an age now where I am concerned about their health almost as much as I am about my own. Being an only child, their care will fall to me. This was the situation in which my mother found herself, when my grandmother’s health began to fail; my mother is also an only child, and managed her mother’s care on her own for many years, until she passed away in 2006.

Today, in retrospect, I feel regret for not doing more — for not helping my mom out more, though from my convenient distance 1,500 miles away, and my natural disinclination toward the dispensing of care, I don’t know how much help I could have been. Maybe I feel badly about that, about having left, about not having been near enough as my grandmother slid slowly into oblivion, to be there for my grandmother, yes, but to be there for my mother too. Maybe I feel badly that I don’t know how to take care of anyone but myself, really, because it took me this long just to figure that part out, and therefore even if I were nearer by I don’t know how I would have cared for my mom while she was caring for hers.

Not that she would have let me. My mom, like myself, is not a person given to accepting kindness or sympathy easily; she, like me, lives by a soundless and seemingly effortless strength that has carried her smoothly through a thousand different life crises, through crashing waves that threatened to shatter a less sturdy soul, over hopeless deserts that seemed to have no end (of course, they did). I know she had bad days, days when she thought she couldn’t keep going, but she shielded them from me.

Nothing has ever cut me through the heart like hearing my mother cry, because it is a thing I have seen happen maybe five times in my entire life.

I found out my grandmother had died on a Saturday, the first of September, six years ago. I was standing in the sunny parking lot of the Liberty Tree Mall in Danvers, Massachusetts, listening to a voicemail my mom had left earlier that day. She didn’t tell me why she was calling, just to call her back, her voice as even and measured as always, but I felt it before she answered my return call, felt it in her "hello" such that when the confirming words came through I already knew what they would say, and only then did I feel that terribleness, only then did I think, why didn’t I do more? Visit more? Call more?

From my distant high-walled castle, I could ignore my grandmother’s growing senility, her strange days, I could pretend it was a movie happening to someone else, and my grandmother and the intimately familiar house she lived in and my closeness to her from infancy were all sharp and intact realities, not memories of a long ago time, not yet.

Sometimes I still mourn my grandmother’s house, the house she eventually left after a single fall on her driveway started her on the long, multi-year decline that ended in her 91st year. I was not there to pack it up and move her to the assisted living home; I never said goodbye.

Other people live in that house now, and while it’s just a house, I knew every corner and crevice, every turning of the wood on the dining-room chairs and every divot in the kitchen linoleum, the grey veins unfurling in the white marble windowsills, the different feels of each upholstered fabric, the sticking circular channel knob on the television’s cable box — I knew it all by heart because I had begun my explorations of that house as a child and over the years left no detail unremarked upon.

My mother dealt with my grandmother’s care largely alone, giving up weekends and dedicating herself without the slightest hint of sacrifice or altruism — she did things because they needed to be done, and she needed to be the one to do them. Odds are good that I will one day follow in the path she laid out. There is a satisfying tidiness to this process, to this circular caretaking, one generation of another, a symbiosis of need.

The one thing that sticks in my throat at the prospect of not having children of my own is that failing to do so will leave my husband and I without a prospect for familial care when we age — not that this is a reason to have kids. Possibly by then we will be supported entirely by our cats, who will owe us, if not for their own care but on behalf of all cats everywhere, whose friends we have been.

The ability to do as much as we have for this cat, this Rufus, is an enormous privilege, and I know it. Every visit to the Very Expensive Special Animal Hospital reminds me of this — that I have not yet had to be the person who elects euthanasia because the cost of treatment is beyond what I can afford, that I have the resources both financial and emotional to spare, even if I am stingier with the latter than the former. When I have been among the bereaved and sobbing in the waiting area, it was because I knew the animal we were putting down could not survive with any amount of intervention, that no volume of money would render that pet immortal.

My visits also remind me of the shocking state of healthcare in the United States, where dogs have cardiologists but humans use emergency rooms as primary care. However, I refuse to shoulder guilt or suffer judgment for doing so much. It’s the choice I have made and I’m sticking by it.

The obvious difference between caring for a sick pet and caring for a sick person is that pets can be legally euthanized, and while many people might cock an eyebrow at spending money on the care of an animal that I will inevitably outlive, I have yet to lose hope that Rufus will, at some point, recover from this illness and return to a good strong life yet.

With people, keeping hope is non-optional, because there is no other course — you stay positive and hope for the best, because giving up doesn’t mean it’s over, it just means you’ve given up, and if you’re me, you never give up hope so long as there is a single tattered shred left to cling to.

With pets, the hope is a battle, because the option to end it is clear. This could all be turned off, all of it, like a switch, tomorrow, with a sedative and a lethal injection. You have to fight for hope for a sick cat, you have to keep convincing yourself that it’s worth it, that you’re not utterly mad for going so far, for doing so much, for spending a summer in tube-feedings every four hours and various medications every two, when you know that someday, you will see this animal die anyway, just maybe a few more years from now, if you’re fortunate, if things work out, ifeverything really is fine, it really is.

It makes you like yourself more, it makes you realize you can do a lot, give up a lot, and still get by, that you are less self-absorbed than you might have feared, and that your 35 years have not erased your ability to believe in miracles.

It is good, and useful, to be reminded that I can still hope, and that maybe, with practice, I can care. Maybe this is, as my mother said, preparation for life, as it seems these are things essential to the endeavor.